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Stoll N, Dey M, Norton S, Adas M, Bosworth A, Buch MH, Cope A, Lempp H, Galloway J, Nikiphorou E. Understanding the psychosocial determinants of effective disease management in rheumatoid arthritis to prevent persistently active disease: a qualitative study. RMD Open 2024; 10:e004104. [PMID: 38609321 PMCID: PMC11029421 DOI: 10.1136/rmdopen-2024-004104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND According to epidemiological studies, psychosocial factors are known to be associated with disease activity, physical activity, pain, functioning, treatment help-seeking, treatment waiting times and mortality in people with rheumatoid arthritis (RA). Limited qualitative inquiry into the psychosocial factors that add to RA disease burden and potential synergistic interactions with biological parameters makes it difficult to understand patients' perspectives from the existing literature. AIM This study aimed to gather in-depth patient perspectives on psychosocial determinants that drive persistently active disease in RA, to help guide optimal patient care. METHODS Patient research partners collaborated on the research design and materials. Semistructured interviews and focus groups were conducted online (in 2021) with patients purposively sampled from diverse ethnicities, primary languages, employment status and occupations. Data were analysed using inductive thematic analysis. RESULTS 45 patients participated across 28 semistructured interviews and three focus groups. Six main themes on psychosocial determinants that may impact RA management were identified: (1) healthcare systems experiences, (2) patient education and health literacy, (3) employment and working conditions, (4) social and familial support, (5) socioeconomic (dis)advantages, and (6) life experiences and well-being practices. CONCLUSION This study emphasises the importance of clinicians working closely with patients and taking a holistic approach to care that incorporates psychosocial factors into assessments, treatment plans and resources. There is an unmet need to understand the relationships between interconnected biopsychosocial factors, and how these may impact on RA management.
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Affiliation(s)
- Nkasi Stoll
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Rheumatic Disease, King's College London Faculty of Life Sciences & Medicine, London, UK
| | - Mrinalini Dey
- Department of Inflammation Biology, King's College London, London, UK
| | - Sam Norton
- Academic Department of Rheumatology, King's College London, London, UK
| | - Maryam Adas
- School of Immunology & Microbial Sciences, King's College London Faculty of Life Sciences & Medicine, London, UK
| | | | - Maya H Buch
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Andrew Cope
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Heidi Lempp
- Department of Inflammation Biology, King's College London, London, UK
| | - James Galloway
- School of Medical Education, King's College London, London, UK
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London, London, UK
- Rheumatology Department, King's College Hospital NHS Trust, London, UK
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Kirkeskov L, Bray K. Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis. BMC Rheumatol 2023; 7:41. [PMID: 37964371 PMCID: PMC10644429 DOI: 10.1186/s41927-023-00365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA. METHODS The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle-Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I2-statistics were calculated. This review was registered with PROSPERO (CRD42020189057). RESULTS Ninety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4-100) at disease onset; 47.0% (range 18.5-100) at study entry, and 40.0% (range 4-88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities. Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting. CONCLUSIONS The findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.
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Affiliation(s)
- Lilli Kirkeskov
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark.
| | - Katerina Bray
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Holbaek, Denmark
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Madsen CMT, Primdahl J, Bremander A, Eggen L, Christensen JR. Developing a complex vocational rehabilitation intervention for patients with inflammatory arthritis: the WORK-ON study. BMC Health Serv Res 2023; 23:739. [PMID: 37422649 DOI: 10.1186/s12913-023-09780-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND People with inflammatory arthritis often experience challenges at work and balancing paid work and energy in everyday life. Low work ability is common, and people with inflammatory arthritis face high risks of losing their jobs and permanent exclusion from the labour market. Context-specific tailored rehabilitation targeting persons with inflammatory arthritis is limited. The aim of this study is to describe the development of WORK-ON - a vocational rehabilitation for people with inflammatory arthritis. METHODS Following the Medical Research Council's framework for complex interventions, WORK-ON was developed based on existing evidence, interviews with patients and rehabilitation clinicians, a workshop, and an iterative process. RESULTS The six-month vocational rehabilitation, WORK-ON, consists of 1) an initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation, 2) coordination by the same occupational therapist and individual support, including navigating across the primary and secondary health sectors, as well as social care, 3) group sessions for peer support, and 4) optionally individually tailored consultations with physiotherapists, nurses, or social workers. CONCLUSION WORK-ON is ready to be tested in a feasibility study. TRIAL REGISTRATION The Regional Committees on Health Ethics for Southern Denmark stated that no formal ethical approval was necessary in this study (20,192,000-105).
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Sygehus Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Linda Eggen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Public Health, User Perspectives and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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4
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McGagh D, McGowan N, Hinds C, Saunders KEA, Coates LC. Actigraphy-derived physical activity levels and circadian rhythm parameters in patients with psoriatic arthritis: relationship with disease activity, mood, age and BMI. Ther Adv Musculoskelet Dis 2023; 15:1759720X231174989. [PMID: 37435529 PMCID: PMC10331082 DOI: 10.1177/1759720x231174989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 07/13/2023] Open
Abstract
Background Psoriatic arthritis (PsA) is associated with sleep disturbance, depression and a lifetime risk of obesity and cardiovascular disease. To date, there have been no studies investigating the relationship between objectively-measured physical activity (PA) levels and circadian rhythm disturbance with disease activity, daily symptoms and mood in patients with PsA. Objective This pilot study aimed to investigate the relationship between disease activity, daily symptoms and mood on PA and circadian rhythm in PsA. Design A prospective cohort study recruiting adults with PsA from rheumatology clinics at a single centre in the UK. Methods Participants wore an actigraph and recorded their symptoms and mood on a daily basis via a smartphone app for 28 days. Time spent in sedentary, light and moderate-to-vigorous physical activity (MVPA) and parameters reflecting the circadian rhythm of the rest-activity pattern were derived. This included the onset time of the least active 5-h (L5) and most active 10-h (M10) daily consecutive periods and the relative amplitude (RA). The relationship factors between baseline clinical status, daily symptoms, PA and circadian measures were examined using linear mixed effect regression models. Results Nineteen participants (8/19 female) were included. Participants with active PsA spent 63.87 min (95% CI: 18.5-109.3, p = 0.008) more in inactivity and 30.78 min (95% CI: 0.4-61.1, p = 0.047) less in MVPA per day compared to those in minimal disease activity (MDA). Age, body mass index and disease duration were also associated with PA duration. Participants with worse functional impairment had an M10 onset time 1.94 h (95% CI: 0.05-3.39, p = 0.011) later than those with no reported functional impairment. No differences were detected for L5 onset time or RA. Higher scores for positive mood components such as feeling energetic, cheerful and elated were associated with less time in inactivity and greater time spent in MVPA overall. Conclusion Our study highlights differences in PA and circadian rest-activity pattern timing based on disease activity, disability and daily mood in PsA. Reduced PA levels in patients with active disease may contribute to the observed increased risk of cardiovascular and metabolic sequelae, with further studies exploring this need.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar
Research Centre, Old Road, Headington, Oxford, OX3 7LD, UK
| | - Niall McGowan
- Sleep and Circadian Neuroscience Institute,
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford,
Oxfordshire, UK
- Department of Psychiatry, University of Oxford,
Oxford, UK
| | - Chris Hinds
- Oxford Digital Phenotyping Laboratory, Big Data
Institute, University of Oxford, Oxford, UK
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford,
Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford
Hospital, Oxford, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
UK
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Wieczorek M, Verstappen SM, Putrik P, Gwinnutt JM, Balanescu A, Bischoff-Ferrari HA, Boonen A, Cavalli G, de Souza S, de Thurah A, Dorner TE, Moe RH, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda M, Guillemin F. Association of vocational interventions and work-related factors with disease and work outcomes in people with RMDs: A systematic review. Semin Arthritis Rheum 2023; 58:152135. [PMID: 36434893 DOI: 10.1016/j.semarthrit.2022.152135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/20/2022] [Accepted: 11/11/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE A EULAR taskforce was convened to develop recommendations for lifestyle behaviours amongst people with rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on work-related factors and disease-specific outcomes for people with osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis (SSc) and gout. METHODS Two separate systematic literature reviews (SLRs) were conducted. The first identified SLRs, published between 01/2013 and 09/2018. The second identified original observational and intervention studies published before 05/2019. Manuscripts were included if they assessed the effects of vocational interventions on disease-specific outcomes (i.e. clinical outcomes, patient-reported outcomes, and work outcomes) or if they assessed the association between work-related factors and these outcomes. Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases were searched. RESULTS Two SLRs were identified including individuals with SSc and inflammatory arthritis. Subsequently, 23 original manuscripts were identified, with most of them (43.5%) including people with RA and no manuscripts on gout. Most observational studies evaluated the association between work-related factors and work outcomes while limited information was available on the impact of work on clinical outcomes. A few studies suggested that physically demanding jobs have a small detrimental effect on radiographic progression in axSpA and PsA. Intervention studies showed beneficial effects of vocational interventions for disease-specific outcomes, but with small effect sizes. CONCLUSION Many studies indicated that work participation is not likely to be detrimental and, in some cases, may be beneficial for RMD-specific outcomes and should therefore receive attention within healthcare consultations.
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Affiliation(s)
- Maud Wieczorek
- Université de Lorraine, EA 4360 Apemac, Nancy, France; Centre on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
| | - Suzanne Mm Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK.
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology Department, "Sf Maria Hospital", "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, United Kingdom
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria; Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria; Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Spain; Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department. Hospital Universitari Son Espases. Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia; Department of Internal Medicine University of East Sarajevo Medical Faculty Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- Université de Lorraine, EA 4360 Apemac, Nancy, France; Inserm, CHRU Nancy, Université de Lorraine, CIC-1433 Epidémiologie Clinique, Nancy, France
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6
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Curry PDK, Morris AP, Barton A, Bluett J. Do genetics contribute to TNF inhibitor response prediction in Psoriatic Arthritis? THE PHARMACOGENOMICS JOURNAL 2023; 23:1-7. [PMID: 36243888 PMCID: PMC9925377 DOI: 10.1038/s41397-022-00290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 02/15/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous chronic musculoskeletal disease, affecting up to 30% of people with psoriasis. Research into PsA pathogenesis has led to the development of targeted therapies, including Tumor Necrosis Factor inhibitors (TNF-i). Good response is only achieved by ~60% of patients leading to 'trial and error' drug management approaches, adverse reactions and increasing healthcare costs. Robust and well-validated biomarker identification, and subsequent development of sensitive and specific assays, would facilitate the implementation of a stratified approach into clinical care. This review will summarise potential genetic biomarkers for TNF-i (adalimumab, etanercept and infliximab) response that have been reported to date. It will also comment upon the importance of managing clinical confounders when understanding drug response prediction. Variants in multiple gene regions including TNF-A, FCGR2A, TNFAIP3, TNFR1/TNFR1A/TNFRSF1A, TRAIL-R1/TNFRSF10A, FCGR3A have been reported to correlate with TNF-i response at various levels of statistical significance in patients with PsA. However, results were often from heterogenous and underpowered cohorts and none are currently implemented into clinical practice. External validation of genetic biomarkers in large, well-documented cohorts is required, and assessment of the predictive value of combining multiple genetic biomarkers with clinical measures is essential to clinically embed pharmacogenomics into PsA drug management.
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Affiliation(s)
- Philippa D K Curry
- Versus Arthritis Centre for Genetics and Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Andrew P Morris
- Versus Arthritis Centre for Genetics and Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Anne Barton
- Versus Arthritis Centre for Genetics and Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - James Bluett
- Versus Arthritis Centre for Genetics and Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK. .,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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7
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Oyebanjo S, Amlani-Hatcher P, Williams R, Stevens R, Esterine T, Wilkins K, Jacklin C, Hamilton J, Fairfax R, Lempp H. Development of a patient-led clinic visit framework: a case study navigating a patient's journey for rheumatology outpatient clinic consultations in England and Wales. BMC Rheumatol 2022; 6:89. [PMID: 36434674 PMCID: PMC9700913 DOI: 10.1186/s41927-022-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Involving patients and members of the public in healthcare planning is beneficial for many reasons including that the outcomes focus on topics relevant to service users. The National Early Inflammatory Arthritis Audit (NEIAA) aims to improve care quality for patients with inflammatory arthritis. CASE STUDY This paper presents a case study detailing how the NEIAA Patient Panel worked with NEIAA governance groups, the National Rheumatoid Arthritis Society and the National Axial Spondyloarthritis Society to co-create an outpatient clinic visit framework for rheumatology professionals. A framework was co-created, divided into nine sections: pre-appointment preparation, waiting area (face-to-face appointments), face-to-face consultations, physical examination, establishing a forward plan, post consultation, annual holistic reviews, virtual appointments and key considerations. Providing insight into how the multi-disciplinary team can meet the diverse needs of patients with inflammatory arthritis, this framework now informs the teaching content about people who live with physical and mental disability for Year 3 and 4 undergraduate medical students at King's College London. CONCLUSION Patients play an important role in helping to address gaps in health service provision in England/Wales. The co-production of a clinic visit framework, informed by their own lived experience and their own expectations can lead to improved and relevant outcomes for the benefit of patients and raises awareness to medical students what matters to patients with physical disabilities when attending outpatient care.
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Affiliation(s)
- Sarah Oyebanjo
- grid.453670.30000 0001 0946 3421British Society for Rheumatology, Bride House, 18-20 Bride Lane, London, EC4Y 8EE UK
| | | | - Ruth Williams
- grid.13097.3c0000 0001 2322 6764Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, King’s College London, Cutcombe Road, 10, Cutcombe Rd, Weston Education Centre, London, SE5 9RJ UK
| | | | - Tom Esterine
- grid.13097.3c0000 0001 2322 6764Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, King’s College London, Cutcombe Road, 10, Cutcombe Rd, Weston Education Centre, London, SE5 9RJ UK
| | - Kate Wilkins
- grid.13097.3c0000 0001 2322 6764Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, King’s College London, Cutcombe Road, 10, Cutcombe Rd, Weston Education Centre, London, SE5 9RJ UK
| | - Clare Jacklin
- National Rheumatoid Arthritis Society, Ground Floor, 4 Switchback Office Park, Gardner Road, Maidenhead, SL6 7RJ Berkshire UK
| | - Jill Hamilton
- National Axial Spondyloarthritis Society, 172 King Street, Hammersmith, London, W6 0QU UK
| | - Rosie Fairfax
- Architects Registration Board, 8 Weymouth Street, London, W1W 5BU UK
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, King’s College London, Cutcombe Road, 10, Cutcombe Rd, Weston Education Centre, London, SE5 9RJ UK
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8
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Abstract
Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with a chronic, progressive course. Various aspects of PsA, including its clinical features, disease course and response to treatment, are influenced by sociodemographic characteristics of the patient. This includes patient sex, the biological attributes associated with being male or female, and gender, a sociocultural construct that comprises attitudes, traits and behaviours associated with being a man or a woman. An understanding of sex- and gender-related differences in PsA, as well as their underlying mechanisms, is therefore important for individualized care. In this narrative review, the influence of sex and gender on PsA manifestation and course, patient function and quality of life, and their association with comorbidities are described. Sex- and gender-related disparities in response to advanced therapies and their potential underlying mechanisms are delineated. Differences in pathophysiological mechanisms between male and female patients including genetics, immune and hormonal mechanisms are discussed. Finally, fertility and pregnancy outcomes in PsA are outlined. By adopting sex and gender lenses, this review is aimed at highlighting key differences between male and female patients with PsA and uncovering mechanisms underlying these differences, ultimately promoting individualized care of men and women with PsA and informing future research in this area.
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9
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Madsen CMT, Bisgaard SK, Primdahl J, Christensen JR, von Bülow C. A Systematic Review of Job Loss Prevention Interventions for Persons with Inflammatory Arthritis. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:866-885. [PMID: 33782815 DOI: 10.1007/s10926-021-09972-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Purpose To present an overview of the evidence of the effect of job loss prevention interventions, aiming to improve work ability and decrease absenteeism and/or job loss in persons with inflammatory arthritis (IA). Method A systematic literature search in the databases PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. A search strategy used in a review from 2014 was copied and additional keywords were added with no time restriction. The Cochrane Risk of Bias Tool (RoB 1) was used for quality assessment and the overall quality of each study was determined using predetermined cut-off criteria, categorising studies to be of good-, acceptable- or low quality. Results were summarised narratively. Results Six randomised controlled trials (published in seven articles) were included, one of good quality and five of acceptable quality. One study identified significant improvements in work ability, while three found no significant difference between groups. One study identified significant difference in absenteeism, while two studies identified no difference between the intervention and control groups. Two studies identified significant reduction in job loss, while two studies identified no group difference. The inconsistent results may be due to heterogeneity in interventions and outcome measures used, and the results should therefore be interpreted with caution. Conclusion The results indicate that job loss prevention interventions may have an effect on work ability, absenteeism and in particular job loss among persons with IA. Further good-quality studies regarding job loss prevention interventions for people with IA are still recommended.
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Affiliation(s)
| | - Sara Kjær Bisgaard
- Department of Public Health, University of Southern Denmark Mark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | | | - Cecilie von Bülow
- Department of Public Health, University of Southern Denmark Mark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
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10
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Madsen CMT, Christensen JR, Bremander A, Primdahl J. Perceived challenges at work and need for professional support among people with inflammatory arthritis - a qualitative interview study. Scand J Occup Ther 2021:1-10. [PMID: 34644224 DOI: 10.1080/11038128.2021.1989483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People with inflammatory arthritis (IA) often experience low work ability, and up to 38% lose their jobs during the initial years after the diagnosis of IA. AIM We explore the perceived challenges at work and identify the need for professional support among Danish people with IA. MATERIALS/METHODS Individual explorative interviews based on a hermeneutic approach. We used Graneheim and Lundman's qualitative content analysis. RESULTS Eleven women and four men with IA (aged 36-68 years) who worked full or part time, or were on short-term sick leave, participated. The analysis revealed one main theme, Balancing work as part of everyday life, and four sub-themes: 1) Working despite challenges, 2) Prioritising energy for work, 3) Fatigue leading to lack of control, and 4) Need for flexibility and recognition. CONCLUSIONS People with IA prioritise staying at work despite experiencing challenges with fatigue and balancing their work and energy in everyday life. They need recognition, support and flexibility at work to be able to continue in their jobs. SIGNIFICANCE The study highlights the need to be aware of occupational balance and, thus, to include other aspects in life apart from just work. It points at occupational therapists as relevant partners in vocational rehabilitation.
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research unit of User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark mark, Odense, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
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11
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Abstract
BACKGROUND Rheumatoid arthritis is often associated with work disability, a term used to describe the inability to be or to remain employed. Work disability is a common implication of rheumatoid arthritis. OBJECTIVE This review aims to identify and analyze the predictive factors of work disability among patients with rheumatoid arthritis, as well as to group these factors into broader categories, based on the most current studies in this field. METHODS An electronic search was conducted using Google Scholar, MEDLINE and PsycINFO databases. Eighty-six international journal articles were finally selected. RESULTS The results suggest that occupational, personal, medical and societal factors are the main predictive categories of work disability for people with rheumatoid arthritis. CONCLUSIONS Medical progress has had a positive effect on the development and the rates of work disability among patients with RA. Work disability is, however, not only defined by medical factors. Occupational, personal and societal factors interact with each other and affect the development of work disability in RA. The results of this review emphasize the need for medical and vocational therapy interventions, social support and state policies that target the work status of patients with RA. Future holistic research approaches to the field are required for a complete picture and concrete solutions with the aim of keeping patients with RA employed.
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Affiliation(s)
- Doxa Papakonstantinou
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia street, 54636, Thessaloniki, Greece. Tel.: +30 2310 891403; E-mail: ; ORCID: https://orcid.org/0000-0002-3242-7629
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12
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Nikiphorou E, Carvalho PD, Boonen A, Fautrel B, Richette P, Machado PM, van der Heijde D, Landewé R, Ramiro S. Sick leave in early axial spondyloarthritis: the role of clinical and socioeconomic factors. Five-year data from the DESIR cohort. RMD Open 2021; 7:rmdopen-2021-001685. [PMID: 34172511 PMCID: PMC8237733 DOI: 10.1136/rmdopen-2021-001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the occurrence of sick leave (SL) and the impact of clinical and socioeconomic factors on SL in early axial spondyloarthritis (axSpA). METHODS Patients with a clinical diagnosis of axSpA from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort with work-related data and up to 5-year follow-up were studied. Incidence, time to first SL and potential role of baseline and time-varying clinical and socioeconomic factors (age, gender, ethnicity, education, job type, marital and parental status) were analysed. Univariable analyses, followed by collinearity and interaction tests, guided subsequent multivariable time-varying Cox survival model building. RESULTS In total, 704 axSpA patients were included (mean (SD) age 33.8 (8.6); 46% men). At baseline, 80% of patients were employed; of these, 5.7% reported being on SL. The incidence of SL among those at risk during the study period (n=620, 88%) was 0.05 (95% CI 0.03 to 0.06) per 1000 days of follow-up. Mean (SD) time to first SL was 806 (595) days (range: 175-2021 days). In multivariable models, male gender (HR 0.41 (95% CI 0.20 to 0.86)) and higher education (HR 0.48 (95% CI 0.24 to 0.95)) were associated with lower hazard of SL, while higher disease activity (HR 1.49 (95% CI 1.04 to 2.13)), older age, smoking and use of tumour necrosis factor inhibitors were associated with higher hazard of SL. CONCLUSIONS In this early axSpA cohort of young, working-age individuals, male gender and higher education were independently associated with a lower hazard of SL, whereas older age and higher disease activity were associated with higher hazard of SL. The findings suggest a role of socioeconomic factors in adverse work outcomes, alongside active disease.
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Affiliation(s)
- Elena Nikiphorou
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands .,Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital, London, UK
| | - Pedro D Carvalho
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Maastricht University Medical Center, Department of Internal Medicine, Division of Rheumatology, Maastricht, The Netherlands
| | - Bruno Fautrel
- Sorbonne University - Assistance Publique Hopitaux de Paris, Pitie Salpetriere Hospital, Dept of Rheumatology. Pierre Louis Institute for Epidemiology and Public Health, INSERM UMRS 1136, PEPITES Teams, Paris, France
| | - Pascal Richette
- Université de Paris, Hopital Lariboisière, Department of Rheumatology, INSERM U1132, Paris, France
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Desirée van der Heijde
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands.,Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sofia Ramiro
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands.,Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands
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13
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Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 TO 2020. Clin Rheumatol 2021; 40:4933-4942. [PMID: 34287723 PMCID: PMC8599387 DOI: 10.1007/s10067-021-05839-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. METHODS Adults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated. RESULTS 4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001). CONCLUSION Annual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease. Key points • Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA. • Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.
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14
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Gwinnutt JM, Leggett S, Lunt M, Barton A, Hyrich KL, Walker-Bone K, Verstappen SMM. Predictors of presenteeism, absenteeism and job loss in patients commencing methotrexate or biologic therapy for rheumatoid arthritis. Rheumatology (Oxford) 2021; 59:2908-2919. [PMID: 32097471 PMCID: PMC7516097 DOI: 10.1093/rheumatology/keaa027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Work is an important health outcome. This study aimed to identify predictors of work loss, absenteeism and presenteeism over 1 year in RA patients commencing treatment with MTX or biologics. Methods Patients aged 18–65 years in full/part-time employment from two UK prospective cohorts were included: MTX-starters = Rheumatoid Arthritis Medication Study; and biologic-starters = Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Presenteeism and absenteeism were assessed using the RA-specific Work Productivity Survey at baseline, and 6 and 12 months. Potential predictors including baseline age, gender, clinical measures (e.g. disability, pain, fatigue), psychological distress, occupation and EULAR response from baseline to 6 months were investigated. Results A total of 51/463 MTX-starters and 30/260 biologic-starters left work over 12 months. Higher baseline psychological distress in MTX-starters [odds ratio (OR) 1.1 (95% CI: 1.0, 1.1)] and higher disability in biologic-starters [OR 3.5 (95% CI: 1.4, 8.6)] predicted work loss. Some 16.1% of patients reported sick-leave, which was predicted by disability [OR (95% CI): MTX-starters: 1.5 (0.9, 2.3); biologic-starters: 2.4 (1.1, 5.2)]. Median presenteeism scores were very low (minimal interference) in both cohorts. Higher fatigue for MTX starters [incidence rate ratio 1.2 (95% CI: 1.0, 1.4)] and higher disability in biologic-starters (incidence rate ratio 1.4 (95% CI: 1.1, 1.7)] predicted presenteeism. Good EULAR response was associated with lower absenteeism and presenteeism in both cohorts. Conclusion Patients with RA still face significant limitations regarding their ability to work. Disability and EULAR response were the main predictors of work outcomes, emphasizing the need to control the disease and the importance of function in enabling work participation.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Sarah Leggett
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Syngle D, Singh A, Verma A. Impact of rheumatoid arthritis on work capacity impairment and its predictors. Clin Rheumatol 2019; 39:1101-1109. [PMID: 31838638 DOI: 10.1007/s10067-019-04838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A decline in work capacity is an important outcome of rheumatoid arthritis (RA). In a first such study from India, we evaluated the impact of RA on work capacity and its predictors. METHODOLOGY We included 52 RA patients meeting 2010 Rheumatoid Arthritis Classification Criteria. Clinical history, physical examination and HAQ-DI, to assess the functional capability, were done. Information on socio-demographic, working and financial conditions of the patients was collected. Disease-specific characteristics: DAS28, ESR and CRP were included. Statistical analysis was carried out using Pearson's exact chi-square analysis. RESULTS Among 52 RA patients, 10 patients had retired from their jobs before diagnosis, and 42 were of working age. Mean disease duration was 6.85 years (range 0.3-26 years). A total of 73% of patients suffered impaired work capacity: reduced working hours (48%), changed their job (8%) and left the labour force early (17%), while 27% had no work capacity impairment. Reduced working hours was significantly associated with lower educational level (p = 0.03), lower monthly income (p = 0.02), manual job (p = 0.01) and concerning disease-related factors: DAS-28 (p = 0.008), CRP level (p = 0.007) and HAQ-DI (p = 0.01). However, leaving the labour force early was related to no medical insurance (p = 0.04) and manual job (p = 0.02). No significant effect was seen in the group with job change. CONCLUSION RA impacts work capacity in Indian population. Socio-demographics (educational level, monthly income, job type) and disease-related factors (disease activity, CRP, physical function) are potential predictors for work capacity impairment in RA. Manual job and absence of medical insurance predicted leaving the labour force before official retirement age due to RA.Key Points• A decline in work capacity is an important outcome of the disease.• Attention has not been paid to this issue in India.• Potential predictors for work capacity impairment in RA include: educational level, monthly income, job type, disease activity, CRP, physical function.• Targeting the predictors may result in reducing work capacity impairment in RA.
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Affiliation(s)
- Devaansh Syngle
- Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Dehradun, India
| | - Amandeep Singh
- Department of Pharmacology, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Dehradun, Uttarakhand, India.
| | - Amit Verma
- Department of Medicine, Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIM&HS), Dehradun, India
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Not all moderate disease is the same - Identification of disability trajectories among patients with rheumatoid arthritis and moderate disease activity. PLoS One 2019; 14:e0215999. [PMID: 31107887 PMCID: PMC6527224 DOI: 10.1371/journal.pone.0215999] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023] Open
Abstract
Background United Kingdom guidelines for the use of biologic disease modifying anti-rheumatic drugs (bDMARDS) for rheumatoid arthritis (RA) require patients to have active disease (Disease Activity Score [DAS28] >5.1) and have failed ≥2 previous conventional synthetic DMARDs (csDMARD). Patients with moderate disease activity (MDA) do not meet these criteria, yet often have poor outcomes. This study aimed to identify trajectory groups of disability scores over three years in RA patients with MDA. Methods The study included biologic-naïve patients receiving csDMARDs only with MDA (3.2 <DAS28≤ 5.1) when recruited to the control cohort of the British Society for Rheumatology Biologics Register–RA (BSRBR-RA). Disability scores, measured using the Health Assessment Questionnaire (HAQ), were recorded every six months for three years. Trajectories of HAQ scores over follow-up were assessed using latent class growth models (LCGMs). Baseline age, gender, DAS28, symptom duration, rheumatoid factor status, number of prior csDMARDs and co-morbidities were assessed as potential predictors of group membership. Results In total, 1274 patients were included (mean age: 61 years (standard deviation: 12), 71.4% women). The best fitting model included seven HAQ trajectories. These trajectories were horizontal over follow-up and were related to baseline HAQ: very-low (6.8%, baseline (BL) HAQ: 0.22), low (11.5%, BL HAQ: 0.41), low-moderate (17.0%, BL HAQ: 0.93), moderate (13.4%, BL HAQ: 1.09), high-moderate (19.5%, BL HAQ: 1.61), severe (23.2%, BL HAQ: 1.98) and very-severe (8.6%, BL HAQ: 2.54). Higher DAS28, older age, female gender, longer disease duration and more co-morbidities were independently associated with higher HAQ trajectory group. Conclusion There is substantial heterogeneity in baseline HAQ scores in this population, and the trajectories of HAQ scores after baseline are, on average, relatively flat. As bDMARD therapy has been shown to improve HAQ scores, patients with MDA but high HAQ scores may benefit from a more aggressive approach to therapy.
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Archer R, Hock E, Hamilton J, Stevens J, Essat M, Poku E, Clowes M, Pandor A, Stevenson M. Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews. Health Technol Assess 2019; 22:1-294. [PMID: 30501821 DOI: 10.3310/hta22660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. OBJECTIVE To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2). DATA SOURCES Electronic databases (e.g. MEDLINE, EMBASE, The Cochrane Library, Web of Science Conference Proceedings; searched to September 2016), registers, key websites, hand-searching of reference lists of included studies and key systematic reviews and contact with experts. STUDY SELECTION Review 1 - primary studies on the development, external validation and impact of clinical prediction models for selected outcomes in adult early RA patients. Review 2 - primary studies on the interaction between selected baseline covariates and treatment (conventional and biological disease-modifying antirheumatic drugs) on salient outcomes in adult early RA patients. RESULTS Review 1 - 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. Five external validation studies evaluating eight clinical prediction models for radiographic joint damage were also included. c-statistics from internal validation ranged from 0.63 to 0.87 for radiographic progression (different definitions, six studies) and 0.78 to 0.82 for the Health Assessment Questionnaire (HAQ). Predictive performance in external validations varied considerably. Three models [(1) Active controlled Study of Patients receiving Infliximab for the treatment of Rheumatoid arthritis of Early onset (ASPIRE) C-reactive protein (ASPIRE CRP), (2) ASPIRE erythrocyte sedimentation rate (ASPIRE ESR) and (3) Behandelings Strategie (BeSt)] were externally validated using the same outcome definition in more than one population. Results of the random-effects meta-analysis suggested substantial uncertainty in the expected predictive performance of models in a new sample of patients. Review 2 - 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. Most of the results were subject to considerable uncertainty and were not statistically significant. LIMITATIONS The meta-analysis in review 1 was limited by the availability of only a small number of external validation studies. Studies rarely investigated the interaction between predictors and treatment. SUGGESTED RESEARCH PRIORITIES Collaborative research (including the use of individual participant data) is needed to further develop and externally validate the clinical prediction models. The clinical prediction models should be validated with respect to individual treatments. Future assessments of treatment by covariate interactions should follow good statistical practice. CONCLUSIONS Review 1 - uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 - in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics. STUDY REGISTRATION This study is registered as PROSPERO CRD42016042402. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rachel Archer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Munira Essat
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Webers C, Ramiro S, Landewé R, van der Heijde D, van den Bosch F, Dougados M, van Tubergen A, Boonen A. Sick leave and its predictors in ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. RMD Open 2018; 4:e000766. [PMID: 30564453 PMCID: PMC6269643 DOI: 10.1136/rmdopen-2018-000766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the occurrence of ankylosing spondylitis (AS)-related sick leave (SL) over 6 12 years and explore factors predicting first and recurrent SL. Methods Data from employed patients from the Outcome in Ankylosing Spondylitis International Study were used. At each visit, patients indicated the occurrence of SL (yes/no) in the previous inter-assessment period. Cox regressions predicted a first episode of SL. Generalised estimating equations (GEE) explored the association between SL and (time-lagged) predictors. To investigate whether SL predicts new SL, SL in the first year was included as covariate in a separate analysis. Results 139 patients (76% males, mean (SD) age 38.7 (10.0) years) were at risk for SL for an average period of 7.9 years, of whom 88 (63%) reported any SL. In both the Cox baseline predictors model (HR (95% CI)) and the time-varying GEE models (OR (95% CI)), AS Disease Activity Score (1.67, 1.23 to 2.28 (HR); 1.48, 1.07 to 2.03 (OR)); Bath AS Disease Activity Index (1.33, 1.18 to 1.51 (HR); 1.31, 1.15 to 1.49 (OR)), Bath AS Functional Index (1.17, 1.02 to 1.34 (HR); 1.31, 1.16 to 1.47 (OR)) and comorbidity at baseline (GEE only, 1.52, 1.00 to 2.29 (OR)) were associated with SL in separate models, but only in patients with low educational attainment. SL in the first year was an independent predictor of SL over time (OR: 2.62 to 8.37 in different models, all p<0.05). Conclusion Disease activity and physical function predicted first and recurrent SL, but only in patients with low educational attainment. Prior SL results in future SL, and SL should therefore be a signal for support to prevent future adverse work outcome.
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Affiliation(s)
- Casper Webers
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Filip van den Bosch
- Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, AP-HP, Paris, France.,Department of INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Astrid van Tubergen
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Division of Rheumatology, Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Abstract
Psoriatic arthritis (PsA) is a multifaceted disease, with a high impact on patients’ psychological and physical well-being. There is increasing recognition that assessment of both clinical aspects of disease and patient identified concerns, such as fatigue, work disability, and treatment satisfaction need to be addressed. Only then can we fully understand disease burden and make well-informed treatment decisions aimed at improving patients’ lives. In recent years, there has been much progress in the development of unidimensional and composite measures of disease activity, as well as questionnaires capturing the patient’s perspective in psoriatic disease. Despite these advances, there remains disagreement amongst clinicians as to which instruments should be used. As a consequence, they are yet to receive widespread implementation in routine clinical practice. This review aims to summarize currently available clinical and patient-derived assessment tools, which will provide clinicians with a practical and informative resource.
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Tillett W, Bojke L. Work Disability and the Cost-effectiveness of Drugs to Treat Rheumatic Diseases - Time for a New Dialogue? J Rheumatol 2018; 45:1075-1077. [PMID: 30068757 DOI: 10.3899/jrheum.180197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- William Tillett
- Royal National Hospital for Rheumatic Diseases; and Department of Pharmacy and Pharmacology, University of Bath, Bath;
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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Luo X, Deng C, Fei Y, Zhang W, Li Y, Zhang X, Zhao Y, Zeng X, Zhang F. Malignancy development risk in psoriatic arthritis patients undergoing treatment: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:626-631. [PMID: 29929736 DOI: 10.1016/j.semarthrit.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/21/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic and seronegative inflammatory arthritis occurring in patients with psoriasis. The current knowledge about the risk of malignancy associated with psoriatic arthritis (PsA) patients undergoing therapy is controversial. We focused on the relationship between malignancy and therapy and undertook a meta-analysis to address this issue. METHODS A systematic literature search of the PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies and trials. Statistical analysis was conducted using STATA 11.2 software. RESULTS Nine cohort studies were included, corresponding to a total of 43,115 PsA patients undergoing therapy. A significant positive association between therapy and increased risk for overall malignancy was found relative to the general population as the reference group (pooled RR, 1.29; 95% CI: 1.04-1.60). High heterogeneity was found (I2 = 71.37%). Subgroup analysis reported that PsA patients treated with conventional synthetic disease modifying antirheumatic drugs (csDMARDs) presented increased cancer risk (pooled RR, 1.75; 95% CI: 1.40-2.18) but patients treated with biological disease modifying antirheumatic drugs (bDMARDs) did not (pooled RR, 0.957; 95% CI: 0.80-1.14). Compared to controls, patients with PsA undergoing treatment specifically are at increased risk for non-melanoma skin cancers (pooled RR, 2.46; 95% CI: 1.84-3.28). CONCLUSIONS This study allowed the estimation of cancer risk in PsA patients during therapy. Large-scale longitudinal studies will be essential to draw firm conclusions regarding PsA-associated risk for treatment-induced malignancy.
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Affiliation(s)
- Xuan Luo
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Chuiwen Deng
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Yunyun Fei
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China.
| | - Wen Zhang
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Yongzhe Li
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Xuan Zhang
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Yan Zhao
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Xiaofeng Zeng
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
| | - Fengchun Zhang
- Departments of Rheumatology and Clinical Immunology Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, #41 Damucang xidan, Beijing, China
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van der Heijde D, Braun J, Rudwaleit M, Purcaru O, Kavanaugh AF. Improvements in workplace and household productivity with certolizumab pegol treatment in axial spondyloarthritis: results to week 96 of a phase III study. RMD Open 2018; 4:e000659. [PMID: 29670761 PMCID: PMC5903272 DOI: 10.1136/rmdopen-2018-000659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives To evaluate the effect of certolizumab pegol (CZP) on work and household productivity, and on participation in family, social and leisure activities in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic (nr-) axSpA. Methods RAPID-axSpA (NCT01087762) was a phase III, double-blind, placebo-controlled trial to week (Wk) 24, dose-blind to Wk48 and open-label to Wk204. A total of 325 patients were randomised 1:1:1 to placebo, CZP 200 mg Q2W or CZP 400 mg Q4W. The validated arthritis-specific Work Productivity Survey assessed the impact of axSpA on work and household productivity and participation in social activities during the preceding month. Data are shown to Wk96, with responses compared between treatment arms (placebo vs CZP 200 mg and 400 mg dose groups combined) and subpopulations using a non-parametric bootstrap-t method. Results At baseline, 63.2% of placebo and 72.0% of CZP patients were employed. By Wk24, CZP patients reported on average 1.0 fewer days of absenteeism and 2.6 fewer days of presenteeism per month, compared with 0.4 and 0.9 fewer days for placebo. At home, by Wk24, CZP patients reported on average 3.0 household work days gained per month versus 1.3 for placebo. CZP patients reported fewer days with reduced household productivity or days lost for social participation. Similar improvements were observed in AS and nr-axSpA subpopulations and improvements with CZP were maintained to Wk96. Conclusions Compared with placebo, treatment with CZP significantly improved work and household productivity and resulted in greater social participation for patients with axSpA, which could lead to considerable indirect cost gains. Trial registration number NCT01087762.
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Affiliation(s)
| | | | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | | | - Arthur F Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, San Diego, California, USA
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Redeker I, Hoffmann F, Callhoff J, Haibel H, Sieper J, Zink A, Poddubnyy D. Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Ann Rheum Dis 2018. [PMID: 29525776 PMCID: PMC6029638 DOI: 10.1136/annrheumdis-2017-212629] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA). METHODS A stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29-50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data. RESULTS A total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms. CONCLUSIONS The prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.
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Affiliation(s)
- Imke Redeker
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Harrold LR, Stolshek BS, Rebello S, Collier DH, Mutebi A, Wade SW, Malley W, Greenberg JD, Etzel CJ. Rebound in Measures of Disease Activity and Symptoms in Corrona Registry Patients with Psoriatic Arthritis Who Discontinue Tumor Necrosis Factor Inhibitor Therapy after Achieving Low Disease Activity. J Rheumatol 2017; 45:78-82. [PMID: 28966209 DOI: 10.3899/jrheum.161567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Rebound may occur in patients with psoriatic arthritis (PsA) who discontinue TNF inhibitor (TNFi) therapy in low disease activity (LDA). METHODS Using physician and patient reports, we quantified rebound following TNFi discontinuation [defined as Clinical Disease Activity Index (CDAI) score > 10 or TNFi restart] and time to rebound in adults with PsA in LDA (CDAI score ≤ 10) at TNFi discontinuation. RESULTS Rebound occurred in 73% (69/94) of patients soon after discontinuation (median time to rebound 8.0 mos, 95% CI 6.0-12.0). CONCLUSION Rebound occurred frequently in patients with PsA after TNFi discontinuation. TNFi discontinuation after achieving LDA should be carefully considered.
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Affiliation(s)
- Leslie R Harrold
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA. .,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center.
| | - Bradley S Stolshek
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Sabrina Rebello
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - David H Collier
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Alex Mutebi
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Sally W Wade
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Wendi Malley
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Jeffrey D Greenberg
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Carol J Etzel
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
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Akinci A, Kiliç G. Future of Rehabilitation Interventions for Rheumatic Patients in the Mediterranean Region. Mediterr J Rheumatol 2017; 28:70-74. [PMID: 32185260 PMCID: PMC7046026 DOI: 10.31138/mjr.28.2.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022] Open
Abstract
Chronic rheumatic diseases can commonly lead to significant physical disability, reduced health-related quality of life and high economic burden for the societies. In the last decades and despite the availability of novel, effective medical treatment for specific rheumatic diseases, rehabilitation interventions do have a pivot role in improving function and psychological status in these conditions. Several systematic reviews and evidence based management recommendations suggest nonpharmaceutical rehabilitation management as an adjunct to medical therapy. The composition of rehabilitative interventions may extensively vary including therapeutic exercise, patient education, occupational therapy, orthoses, assistive devices, work rehabilitation and physical modalities. Exercise therapy is the main component of non-pharmacological treatment and strongly recommended in international guidelines but currently there is no consensus regarding intensity, frequency, or type of rehabilitation program for patients with rheumatic diseases. So, rehabilitation should be designed on a patient-centered basis in the context of multidisciplinary approach.
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Affiliation(s)
- Aysen Akinci
- Department of Physical Medicine and Rehabilitation, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Gamze Kiliç
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University, Afyonkarahisar Turkey
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26
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Biologics registers in RA: methodological aspects, current role and future applications. Nat Rev Rheumatol 2017; 13:503-510. [PMID: 28569267 DOI: 10.1038/nrrheum.2017.81] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The beginning of the 21st century saw a biopharmaceutical revolution in the treatment of inflammatory rheumatic diseases, particularly rheumatoid arthritis. The fast-evolving use of biologic therapies highlighted the need to develop registers at national and international levels with the aim of collecting long-term data on patient outcomes. Over the past 15 years, many biologics registers have contributed a wealth of data and provided robust and reliable evidence on the use, effectiveness and safety of these therapies. The unavoidable challenges posed by the continuous introduction of new therapies, particularly with regard to understanding their long-term safety, highlights the importance of learning from experience with established biologic therapies. In this Perspectives article, the role of biologics registers in bridging the evidence gap between efficacy in clinical trials and real-world effectiveness is discussed, with a focus on methodological aspects of registers, their unique features and challenges and their role going forward.
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Olofsson T, Petersson IF, Eriksson JK, Englund M, Nilsson JA, Geborek P, Jacobsson LTH, Askling J, Neovius M. Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work? Ann Rheum Dis 2017; 76:1245-1252. [PMID: 28073801 DOI: 10.1136/annrheumdis-2016-210239] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration. METHODS Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression. RESULTS During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration <5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start. CONCLUSIONS A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.
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Affiliation(s)
- T Olofsson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - I F Petersson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - J K Eriksson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - J A Nilsson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - P Geborek
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation, Research Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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28
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Keat A, Bennett AN, Gaffney K, Marzo-Ortega H, Sengupta R, Everiss T. Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents? Rheumatol Int 2016; 37:327-336. [DOI: 10.1007/s00296-016-3635-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022]
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Szántó S, Poór G, Opris D, Iaremenko O, Procházková L, Kuuse R, Nagy O, Chernyshov V, Géher P. Improved clinical, functional and work outcomes in spondyloarthritides during real-life adalimumab treatment in central-eastern Europe. J Comp Eff Res 2016; 5:475-85. [PMID: 27417564 DOI: 10.2217/cer-2016-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Adalimumab effectiveness on clinical, functional and work-related outcomes was evaluated in patients with active ankylosing spondylitis or psoriatic arthritis treated in routine clinical practice in central-eastern Europe. METHODS Patients (n = 555) were followed for 12 months. Primary end point was percentage of patients with a treatment response (≥50% decrease from baseline in Bath Ankylosing Spondylitis Disease Activity Index or ≥1.2 point decrease from baseline in Disease Activity Index-28 joint for axial or peripheral symptoms, respectively). Functional status was evaluated by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire Disability Index. Working ability was evaluated by the Work Productivity and Activity Impairment Questionnaire - Specific Health Problem. RESULTS 76.1% of patients with axial symptoms and 83.5% with peripheral symptoms achieved a treatment response. Frequency of extra-articular manifestations decreased. Improvements were observed in functional status and workability. No new safety signals were observed. CONCLUSION Adalimumab was effective and well tolerated during real-world use in central-eastern Europe.
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Affiliation(s)
- Sándor Szántó
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Poór
- National Institute of Rheumatology & Physiotherapy, Budapest, Hungary
| | | | | | - Leona Procházková
- Rheumatology Division, 2nd Department of Internal Medicine, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Reet Kuuse
- Tartu University Hospital, Tartu, Estonia
| | | | | | - Pál Géher
- Hospitaller Brothers of St John of God Hospital, Budapest, Hungary
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Meunier J, Fautrel B, Roquelaure Y, Claudepierre P. Work-related discussions between French rheumatologists and their rheumatoid arthritis patients. Occup Med (Lond) 2016; 66:454-9. [PMID: 27048296 DOI: 10.1093/occmed/kqw031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) causes significant impairment of physical function, and thus adversely affects patients' ability to work. AIMS To document how often work limitations are discussed by rheumatologists and RA patients during consultations. METHODS We conducted an observational study in a sample of French rheumatologists and in a parallel sample of patients recruited by pharmacists. We asked all rheumatologists in France practising in private practice or mixed practice (private practice and hospital) to participate in a telephone survey about their most recent consultation with an RA patient. Randomly selected pharmacists recruited RA patients to complete a questionnaire about their most recent consultation with their rheumatologist. We included patients aged 20-59, with a paid job or unemployed. We calculated the proportion of consultations including work-related discussions in both samples. RESULTS Of the 1737 rheumatologists contacted, 153 (9%) described consultations with eligible patients. Of the 1200 pharmacists contacted, 39 (3%) recruited 81 RA patients. The proportion of consultations including work-related discussions was 50% [95% confidence interval (CI) 42-58%] in the rheumatologist sample and 52% (95% CI 41-63%) in the patient sample. The most frequent subject of discussion (88%) was physical problems related to work in both samples. CONCLUSIONS This is the first study to document the proportion of consultations where rheumatologists and their RA patients discuss work. Both specialists and patients reported that work was discussed in one in every two consultations.
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Affiliation(s)
- J Meunier
- Mapi Patient-Centered Outcomes, 27 rue de la Villette, 69003 Lyon, France,
| | - B Fautrel
- Université Pierre et Marie Curie, GRC 08, Institut Pierre Louis d'Epidémiologie et Santé publique, AP-HP, Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Y Roquelaure
- Laboratoire d'Ergonomie et d'Epidémiologie en Santé au Travail (LEEST) - Unité associée à l'Institut de veille sanitaire UPRES EA 4336, Université d'Angers, Faculté de Médecine Service de Médecine E, Centre Hospitalier Universitaire, 4 rue Larrey, 49933 Angers Cedex, France
| | - P Claudepierre
- Groupe Henri-Mondor Albert Chenevier, Service de Rhumatologie, AP-HP, Creteil 94010, France, Université Paris Est Créteil, LIC EA4393, Creteil 94010, France
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Fernández García R, Sánchez Sánchez LDC, López Rodríguez MDM, Sánchez Granados G. Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.medcle.2016.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Stolwijk C, Castillo‐Ortiz J, Gignac M, Luime J, Boonen A, Lacaille D, Fautrel B, Tang K, Verstappen S, Escorpizo R, Tugwell P, Beaton D. Importance of Contextual Factors When Measuring Work Outcome in Ankylosing Spondylitis: A Systematic Review by the OMERACT Worker Productivity Group. Arthritis Care Res (Hoboken) 2015; 67:1316-1327. [DOI: 10.1002/acr.22573] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/07/2015] [Accepted: 02/24/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Carmen Stolwijk
- Maastricht University Medical CenterMaastricht The Netherlands
| | - José‐Dionisio Castillo‐Ortiz
- Maastricht University Medical Center, Maastricht, The Netherlands, and Unidad de Investigación en Enfermedades Cronico‐DegenerativasGuadalajara Mexico
| | - Monique Gignac
- Institute for Work and Health, University of Toronto, and University Health NetworkToronto, Ontario Canada
| | - Jolanda Luime
- Erasmus Medical Center and University Medical CenterRotterdam The Netherlands
| | - A. Boonen
- Maastricht University Medical CenterMaastricht The Netherlands
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Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 2015; 29:495-511. [DOI: 10.1016/j.berh.2015.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs 2015; 74:423-41. [PMID: 24566842 PMCID: PMC3958815 DOI: 10.1007/s40265-014-0191-y] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. Up to 40 % of patients with psoriasis will go on to develop PsA, usually within 5-10 years of cutaneous disease onset. Both conditions share common pathogenic mechanisms involving genetic and environmental factors. Because psoriasis is typically present for years before PsA-related joint symptoms emerge, dermatologists are in a unique position to detect PsA earlier in the disease process through regular, routine screening of psoriasis patients. Distinguishing clinical features of PsA include co-occurrence of psoriatic skin lesions and nail dystrophy, as well as dactylitis and enthesitis. Patients with PsA are usually seronegative for rheumatoid factor, and radiographs may reveal unique features such as juxta-articular new bone formation and pencil-in-cup deformity. Early treatment of PsA with disease-modifying anti-rheumatic drugs has the potential to slow disease progression and maintain patient quality of life. Optimally, a single therapeutic agent will control both the skin and joint psoriatic symptoms. A number of traditional treatments used to manage psoriasis, such as methotrexate and cyclosporine, are also effective for PsA, but these agents are often inadequately effective, temporary in benefit and associated with significant safety concerns. Biologic anti-tumour necrosis factor agents, such as etanercept, infliximab and adalimumab, are effective for treating patients who have both psoriasis and PsA. However, a substantial number of patients may lose efficacy, have adverse effects or find intravenous or subcutaneous administration inconvenient. Emerging oral treatments, including phosphodiesterase 4 inhibitors, such as apremilast, and new biologics targeting interleukin-17, such as secukinumab, brodalumab and ixekizumab, have shown encouraging clinical results in the treatment of psoriasis and/or PsA. Active and regular collaboration of dermatologists with rheumatologists in managing patients who have psoriasis and PsA is likely to yield more optimal control of psoriatic dermal and joint symptoms, and improve long-term patient outcomes.
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MESH Headings
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/genetics
- Arthritis, Psoriatic/immunology
- Clinical Trials as Topic
- Drug Therapy, Combination
- Early Diagnosis
- Glucocorticoids/administration & dosage
- Glucocorticoids/adverse effects
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Practice Guidelines as Topic
- Psoriasis/diagnosis
- Psoriasis/drug therapy
- Psoriasis/genetics
- Psoriasis/immunology
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA,
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35
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Zhang X, Mu R, Wang X, Xu C, Duan T, An Y, Han S, Li X, Wang L, Wang C, Wang Y, Yang R, Wang G, Lu X, Zhu P, Chen L, Liu J, Jin H, Liu X, Sun L, Wei P, Wang J, Chen H, Cui L, Shu R, Liu B, Zhang Z, Li G, Li Z, Yang J, Li J, Jia B, Zhang F, Tao J, Lin J, Wei M, Liu X, Ke D, Hu S, Ye C, Yang X, Li H, Huang C, Gao M, Lai P, Li X, Song L, Wang Y, Wang X, Su Y, Li Z. The impact of rheumatoid arthritis on work capacity in Chinese patients: a cross-sectional study. Rheumatology (Oxford) 2015; 54:1478-87. [PMID: 25802400 DOI: 10.1093/rheumatology/kev014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To evaluate the impact of RA on work capacity and identify factors related to work capacity impairment in patients with RA. METHODS A cross-sectional multicentre study was performed in 21 tertiary care hospitals across China. A consecutive sample of 846 patients with RA was recruited, of which 589 patients of working age at disease onset constituted the study population. Information on the socio-demographic, clinical, working and financial conditions of the patients was collected. Logistic regression analyses were used to identify factors associated with work capacity impairment. RESULTS The rate of work capacity impairment was 48.0% in RA patients with a mean disease duration of 60 months (interquartile range 14-134 months), including 11.7% leaving the labour force early, 33.6% working reduced hours and 2.7% changing job. Multivariable logistic regression analysis showed that reduced working hours was significantly related to current smoking [odds ratio (OR) 2.07 (95% CI 1.08, 3.97)], no insurance [OR 1.94 (95% CI 1.20, 3.12)], in manual labour [OR 2.66 (95% CI 1.68, 4.20)] and higher HAQ score [OR 2.22 (95% CI 1.36, 3.60)]. There was an association of current smoking [OR 3.75 (95% CI 1.54, 9.15)], in manual labour [OR 2.33 (95% CI 1.17, 4.64)], longer disease duration [OR 1.01 (95% CI 1.00, 1.01)] and lower BMI [OR 0.90 (95% CI 0.82, 0.99)] with leaving the labour force early. CONCLUSION There is a substantial impact of RA on the work capacity of patients in China. Social-demographic, disease- and work-related factors are all associated with work capacity impairment.
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Affiliation(s)
- Xiaoying Zhang
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center
| | - Rong Mu
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center
| | - Xiuru Wang
- Department of Rheumatology and Immunology, Peking University Shougang Hospital
| | - Chuanhui Xu
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center
| | - Tianjiao Duan
- Department of Gastroenterology, People's Hospital, Peking University Health Science Center, Beijing
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center
| | - Shuling Han
- Department of Rheumatology and Immunology, Peking University Shougang Hospital
| | - Xiaofeng Li
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan
| | - Lizhi Wang
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan
| | - Caihong Wang
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan
| | - Yongfu Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital, Baotou Medical College, Baotou
| | - Rong Yang
- Department of Rheumatology and Immunology, First Affiliated Hospital, Baotou Medical College, Baotou
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an
| | - Lina Chen
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an
| | - Jinting Liu
- Department of Rheumatology and Immunology, Second Hospital of Hebei Medical University, Shijiazhuang
| | - Hongtao Jin
- Department of Rheumatology and Immunology, Second Hospital of Hebei Medical University, Shijiazhuang
| | - Xiangyuan Liu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing
| | - Lin Sun
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing
| | - Ping Wei
- Department of Rheumatology and Immunology, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Junxiang Wang
- Department of Rheumatology and Immunology, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Haiying Chen
- Department of Rheumatology and Immunology, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Liufu Cui
- Department of Rheumatology and Immunology, Affiliated Kailuan Hospital of North China Coal Medical University, Tangshan, Hebei
| | - Rong Shu
- Department of Rheumatology and Immunology, Affiliated Kailuan Hospital of North China Coal Medical University, Tangshan, Hebei
| | - Bailu Liu
- Department of Rheumatology and Immunology, Affiliated Kailuan Hospital of North China Coal Medical University, Tangshan, Hebei
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing
| | - Guangtao Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing
| | - Zhenbin Li
- Department of Rheumatology and Immunology, Bethune International Peace Hospital of PLA, Shijiazhuang
| | - Jing Yang
- Department of Rheumatology and Immunology, Bethune International Peace Hospital of PLA, Shijiazhuang
| | - Junfang Li
- Department of Rheumatology and Immunology, Handan Central Hospital, Handan
| | - Bin Jia
- Department of Rheumatology and Immunology, Handan Central Hospital, Handan
| | - Fengxiao Zhang
- Department of Rheumatology and Immunology, People's Hospital of Hebei Province, Shijiazhuang
| | - Jiemei Tao
- Department of Rheumatology and Immunology, People's Hospital of Hebei Province, Shijiazhuang
| | - Jinying Lin
- Department of Rheumatology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Meiqiu Wei
- Department of Rheumatology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Xiaomin Liu
- Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing
| | - Dan Ke
- Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing
| | - Shaoxian Hu
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Cong Ye
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Xiuyan Yang
- Department of Rheumatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Hao Li
- Department of Rheumatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, Beijing
| | - Ming Gao
- Department of Rheumatology and Immunology, Beijing Hospital, Beijing
| | - Pei Lai
- Department of Rheumatology and Immunology, Beijing Hospital, Beijing
| | - Xingfu Li
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan and
| | - Lijun Song
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan and
| | - Yi Wang
- Deparment of Rheumatology, Second Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoyuan Wang
- Deparment of Rheumatology, Second Hospital of Lanzhou University, Lanzhou, China
| | - Yin Su
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center,
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Fernández García R, Sánchez Sánchez LDC, López Rodríguez MDM, Sánchez Granados G. [Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial]. Med Clin (Barc) 2015; 145:380-4. [PMID: 25639496 DOI: 10.1016/j.medcli.2014.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Spondyloarthritis is a general term referring to a group of chronic rheumatic illnesses that share clinical, genetic, radiological and epidemiological features. The clinical presentation of spondyloarthritis is characterized by the compromise of both the axial and peripheral articular skeleton. We aimed to evaluate the efficacy of an aquatic exercise plus relaxation program in patients with spondyloarthritis. PATIENTS AND METHOD This was a randomized single blind study including 30 patients with spondylitis who were randomly assigned to an experimental or control group. For 2 months, the experimental group underwent an aquatic fitness plus relaxation program (3 sessions per week). Evaluations were also performed in the control group the same days as the experimental group but they did not participate in any supervised exercise program. The following data were obtained at baseline and immediately after application of the last session: Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Health Questionnaire SF-12 and Sigma PC3(®) (Sigma-Elektro GmbH, Neustadt, Germany) Heart Rate Monitor. RESULTS The Mann-Whitney test showed statistically significant differences in the quality of life (physical function [P=.05]), Bath Ankylosing Spondylitis Functional Index (P=.015), Bath Ankylosing Spondylitis Disease Activity Index (fatigue [P=.032], neck pain, back and hips [P=.045], pain or swelling in other joints [P=.032] and in waking morning stiffness [P=.019]). CONCLUSIONS The results of the present study suggest that therapy with physical exercise plus relaxation provides benefits to spondyloarthritis patients and these are advised as a part of their usual treatment.
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Affiliation(s)
- Rubén Fernández García
- Facultad de Ciencias de la Salud, Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, Almería, España.
| | | | - María Del Mar López Rodríguez
- Facultad de Ciencias de la Salud, Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, Almería, España
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Boonen A, Boone C, Albert A, Mielants H. Understanding Limitations in At-work Productivity in Patients with Active Ankylosing Spondylitis: The Role of Work-related Contextual Factors. J Rheumatol 2014; 42:93-100. [DOI: 10.3899/jrheum.131287] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective.To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS).Methods.Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days. In addition, they answered questions about work characteristics (type, characteristics of workplace, satisfaction of contacts with colleagues, and importance of work in life) and health status [Bath AS Functional Index (BASFI), AS Disease Activity Score-C-reactive protein (ASDAS-CRP)]. Physicians assessed the Bath Ankylosing Spondylitis Metrology Index, presence of articular and extraarticular manifestations, comorbidities, and laboratory indicators of inflammation. Stepwise regression models were computed to determine which work-related and health-related factors contributed to WPAI outcomes.Results.The study included 80 patients. The WPAI presenteeism, absenteeism, and overall work productivity loss scores were 49.1%, 30.2%, and 53.1%, respectively. Presenteeism was associated with higher BASFI, female sex, and poor quality of contact with colleagues. Absenteeism was associated with increasing age, current smoking status, higher ASDAS-CRP, and low importance of work for life. Overall work productivity loss was associated with female sex, higher BASFI, past adaptation of job because of illness, number of working hours, and manual profession.Conclusion.Both health-related and contextual factors contribute to work limitations in patients with AS and suggest additional opportunities for improvement by addressing the working environment.
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Dadoun S, Guillemin F, Lucier S, Looten V, Saraux A, Berenbaum F, Durand-Zaleski I, Chevreul K, Fautrel B. Work productivity loss in early arthritis during the first 3 years of disease: a study from a French National Multicenter Cohort. Arthritis Care Res (Hoboken) 2014; 66:1310-8. [PMID: 24497394 DOI: 10.1002/acr.22298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess work productivity (WP) loss during the first 3 years of disease in a cohort of patients with early arthritis (EA) diagnosed between 2002 and 2005. METHODS The ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) cohort included 813 EA patients; we included those of working age at baseline in the present study. WP loss was assessed by 3 components: sick leave, permanent disability, and early retirement. The proportion of affected patients and the mean number of days off work were assessed for each component. WP costs were estimated and determinants of positive and extreme costs were assessed by logistic regression models. RESULTS Among the 664 patients included, 81.6% were in the workforce at baseline. During the first 3 years of disease, 45% reported at least 1 sick leave day and 11% reported permanent disability. Only a few patients (1%) reported early retirement. The mean number of days on sick leave due to EA decreased regularly from 44 to 13, whereas the mean number of days on permanent disability tripled from 10 to 33. The mean annual cost was 1,333 (95% confidence interval 1,075-1,620). Sick leave longer than 30 days due to EA before inclusion and a decrease in mental and physical scores of the Medical Outcomes Study Short Form 36 at inclusion were independent determinants of positive and extreme costs in multivariate models. CONCLUSION WP loss is substantial in EA patients and is due to permanent disability before the third year of disease. Work absence and poor mental and physical health status at baseline are major determinants of WP costs.
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Affiliation(s)
- Sabrina Dadoun
- Pitié-Salpétrière Hospital, AP-HP, and Paris VI University, Paris, France
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Chan CYY, Tsang HHL, Lau CS, Chung HY. Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in axial spondyloarthritis patients. Int J Rheum Dis 2014; 20:317-325. [PMID: 25293872 DOI: 10.1111/1756-185x.12456] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool. METHODS We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders. RESULTS The prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%. CONCLUSION The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
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Affiliation(s)
- Cynthia Y Y Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Helen H L Tsang
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
| | - C S Lau
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.,Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, China
| | - H Y Chung
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
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Kruntorádová K, Klimeš J, Šedová L, Štolfa J, Doležal T, Petříková A. Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis. Value Health Reg Issues 2014; 4:100-106. [DOI: 10.1016/j.vhri.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tillett W, Shaddick G, Askari A, Cooper A, Creamer P, Clunie G, Helliwell PS, Kay L, Korendowych E, Lane S, Packham J, Shaban R, Williamson L, McHugh N. Factors influencing work disability in psoriatic arthritis: first results from a large UK multicentre study. Rheumatology (Oxford) 2014; 54:157-62. [PMID: 25125591 DOI: 10.1093/rheumatology/keu264] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the extent to which structural damage, clinical disease activity, demographic and social factors are associated with work disability (WD) in PsA. METHODS Four hundred patients fulfilling CASPAR (Classification Criteria for Psoriatic Arthritis) criteria for PsA were recruited from 23 hospitals across the UK. Demographic, socio-economic, work, clinical and radiographic data were collected. WD was assessed with the Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire reporting WD as a percentage of absenteeism (work time missed), presenteeism (impairment at work/reduced effectiveness) and work productivity loss (overall work impairment/absenteeism plus presenteeism). Logistic and linear regressions were conducted to investigate associations with WD. RESULTS Two hundred and thirty-six participants of any age were in work. Absenteeism, presenteeism and productivity loss rates were 14% (s.d. 29.0), 39% (s.d. 27.2) and 46% (s.d. 30.4), respectively. Ninety-two (26%) participants of working age were unemployed. Greater age, disease duration of 2-5 years and worse physical function were associated with unemployment. Patients reported that employer awareness and helpfulness exerted a strongly positive influence on remaining in employment. Higher levels of global and joint-specific disease activity and worse physical function were associated with greater levels of presenteeism and productivity loss among those who remained in work. CONCLUSION Reduced effectiveness at work was associated with measures of disease activity, whereas unemployment, considered the endpoint of WD, was associated with employer factors, age and disease duration. A longitudinal study is under way to determine whether treatment to reduce disease activity ameliorates WD in the real-world setting.
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Affiliation(s)
- William Tillett
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
| | - Gavin Shaddick
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Ayman Askari
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Annie Cooper
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Paul Creamer
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Gavin Clunie
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Philip S Helliwell
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Lesley Kay
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Eleanor Korendowych
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Suzanne Lane
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Jonathan Packham
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Ragai Shaban
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Lyn Williamson
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK. Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK
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Effects of anti-TNF alpha drugs on disability in patients with rheumatoid arthritis: long-term real-life data from the Lorhen Registry. BIOMED RESEARCH INTERNATIONAL 2014; 2014:416892. [PMID: 25110678 PMCID: PMC4109221 DOI: 10.1155/2014/416892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 04/29/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
This study involving 1033 patients with RA confirms the effectiveness of etanercept, adalimumab, and infliximab in reducing RA-related disability even in patients with a history of highly active and longstanding RA. Moreover, we found that the improvement in disability was biphasic, with a marked improvement during the first year of anti-TNF therapy, followed by slower but significant recovery over the subsequent four years.
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Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors. Rheumatol Int 2014; 35:107-14. [DOI: 10.1007/s00296-014-3062-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
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Relas H, Kautiainen H, Puolakka K, Virta LJ, Leirisalo-Repo M. Survival of disease-modifying antirheumatic drugs used as the first antirheumatic medication in the treatment of ankylosing spondylitis in Finland. A nationwide population-based register study. Clin Rheumatol 2014; 33:1135-8. [PMID: 24907035 DOI: 10.1007/s10067-014-2700-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 01/06/2023]
Abstract
The tight national drug reimbursement regulations in the treatment of ankylosing spondylitis (AS) in Finland lead to the practice that at least one traditional disease-modifying antirheumatic drug (DMARD), if not contraindicated, has been tried and has failed before a patient can be eligible for reimbursement of anti-tumour necrosis factor (TNF) treatment. The aim of the present study is to evaluate drug survival of the firstly prescribed DMARDs in patients with AS. All AS patients from January 1, 2000 to December 31, 2007 were collected from the nationwide drug reimbursement registry maintained by the Social Insurance Institution (SII). Data on antirheumatic medication came from the prescription registry of SII. A total of 2,890 AS patients (60 % males) were identified. Sulfasalazine (SSA) monotherapy was the most common first antirheumatic treatment (2,319 patients, 87 %), followed by methotrexate (MTX) monotherapy (230 patients, 9 %) and by hydroxychloroquine monotherapy (77 patients, 3 %). A combination of two or more DMARDs was used by 44 patients (2 %). Only seven patients (0.3 %) had biological (etanercept or adalimumab) started as the first antirheumatic drug. Median survival time of SSA monotherapy was 4.5 years (95 % CI 4.2 to 4.8) and that of MTX was 1.9 years (95 % CI 1.5 to 2.1). SSA is almost the standard as the first antirheumatic treatment of AS in Finland. Although the clinical efficiency of SSA was not evaluable in the present study, these data suggest that the use of SSA can at least postpone the need and start of TNF inhibitors with marked economic consequences.
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Affiliation(s)
- Heikki Relas
- Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, PO BOX 372, FI-00029 HUS, Helsinki, Finland,
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Puchner R, Brezinschek HP, Herold M, Nothnagl T, Studnicka-Benke A, Fritz J, Leeb BF. Quality of care of rural rheumatoid arthritis patients in Austria. Wien Klin Wochenschr 2014; 126:360-7. [PMID: 24676628 DOI: 10.1007/s00508-014-0540-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/02/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine how fast rheumatoid arthritis (RA) was diagnosed in a group of patients in a rural area and whether medical care and patient satisfaction were adequate in a predominantly non-urban settlement. METHODS When visiting their rheumatologist, patients with RA were asked to complete a questionnaire at home after the consultation and then return it to an independent opinion research centre, where the data were collected and analysed. The form comprised various areas, namely demography, aspects of the diagnosis, medical care, therapeutic measures and the illness in a personal context. RESULTS Of 150 patients, 127 answered the questionnaire. A total of 63 % of the patients lived in settlements of less than 5,000 inhabitants, and a further 18 % in settlements of more than 5,000-50,000 inhabitants. The rheumatologist attended could be reached within 1 h for 90 % of the patients. In slightly fewer than 30 % of the respondents, the diagnosis of RA was made within 3 months, and in 44%, within 6 months. In 75 %, the diagnosis was made by a rheumatologist. After experiencing the first symptoms, 80 % of the respondents contacted their general practitioner. A high degree of satisfaction appears to originate from the information supplied by the rheumatologist attended. Most patients believed they were involved in decision making regarding their therapy. CONCLUSION The majority of the respondents came from rural areas. RA was diagnosed within 6 months for almost half of the patients questioned. Most patients believed they were well informed and involved in therapeutic decision making.
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Affiliation(s)
- Rudolf Puchner
- Rheumatologist in private practice, Freiung 19, 4600, Wels, Austria,
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Abdul-Sattar A, Abou El Magd S. Prevalence and associated risk factors for work disability in Egyptian patients with ankylosing spondylitis from one center. Int J Rheum Dis 2014; 20:2028-2034. [PMID: 24618084 DOI: 10.1111/1756-185x.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of work disability (WD) in Egyptian patients with ankylosing spondylitis (AS) and to identify the main factors associated with this. METHODS A cross-sectional survey was conducted among all patients with AS during an extended outpatient visit in the period between July, 2011 and December, 2012. Demographic data were collected and a physical examination was performed. Multivariate modeling was applied to determine the factors associated with work disability. RESULTS The questionnaire was completed by 90 patients (85 males; 94.4%). The mean age of the participants was 37.8 (SD 9.7) years, mean disease duration was 12.1 (SD 8.9) years, and the mean symptom duration was 15 (SD 2.9) years. A total of 36 (40%) patients of working age were not working due to AS. The factors that associated with work disability, after completing logistic regression models, were older age (odds ratio [OR] = 1.8, 95%, confidence interval [CI] = 1.04-1.17), longer disease duration (OR = 1.60, 95% CI = 1.12-2.8), increasing diagnostic delay (OR = 2.1, 95% CI = 1.0-3.4), lower educational level (OR = 3.5, 95% CI = 1.6-6.4), manual profession (OR = 1.80, 95% CI = 1.10-2.6), living in a rural zone (OR = 3.14, 95% CI = 1.98-5.05), peripheral arthritis (OR = 2.04, 95% CI = 1.20-3.43) and psychological symptoms (OR = 2.3, 95% CI = 1.9-4.6). CONCLUSION The prevalence of WD among Egyptian patients with AS is considerably high. Clinical and psychosocial factors, in particular, appear to be associated with WD and should therefore be prioritized in clinical practice.
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Affiliation(s)
- Amal Abdul-Sattar
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Sahar Abou El Magd
- Department of Community, Environmental and Occupational Medicine, Zagazig University, Zagazig, Egypt
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Sallai JR, Hunka A, Héjj G, Ratkó I, Ortutay J, Márkus I, Ormos G, Ujfalussy A, Szekeres L, Insperger A, Varjú T, Bálint G. [Survey of quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary]. Orv Hetil 2013; 154:1381-8. [PMID: 23974974 DOI: 10.1556/oh.2013.29645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are limited data about the quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. AIM The aim of the authors was to assess demographic data, social status, health related quality of life, and needs for assistance and disease-related information of 239 rheumatoid arthritis patients (169 women and 7 men) admitted to four rehabilitation centres in Hungary. METHOD For the assessment of demographic, social and other data the authors developed questionnaires. The health related quality of life was evaluated using the validated Short Form 36 questionnaire. RESULTS The authors found that rheumatoid arthritis patients require in-patient rehabilitation relatively early in their disease course. 80.4% of the patients were over 50 years of age, and their social status was low as compared to the average of the Hungarian population. The health related quality of life of patients was significantly lower than that of the average population, but it was similar to the quality of life of patients with osteoarthritis, osteoporosis and low back pain. Among domains of the quality of life, the scores for physical function and pain were the lowest. The most common accompanying diseases included hypertension and osteoporosis. In case of knee and hip surgeries, postoperative rehabilitation was performed in due time. Patients were not satisfied with disease-related information and education given by health care providers. CONCLUSIONS There is poor quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. More efforts should be done to provide disease-related information and education for patients.
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McArthur M, Birt L, Goodacre L. A Narrative Literature Review of the Impact of Anti-TNFα Treatment on the Occupational Performance of People with Rheumatoid Arthritis or Ankylosing Spondylitis. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13807217284260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Anti-TNFα treatment has revolutionised the disease pathway for some people with rheumatoid arthritis and ankylosing spondylitis, although physiological improvements do not always readily translate into re-engagement in occupational activities. This review explores the evidence base for the impact of anti-TNFα on occupational performance. Method: Literature was searched from 2000–11. A four-stage process resulted in the review of 19 articles. The Weight of Evidence framework was used to assess quality and relevance to the review question. Findings: People on anti-TNFα treatment experience increased engagement in functional, psychological and social domains. Most studies focused on employment issues, with conflicting evidence about how well anti-TNFα protected against work disability and very limited evidence that anti-TNFα enabled return to paid work. The increase in productivity was to the detriment of other occupational domains, with resulting occupational imbalance. Conclusion: The assumption that clinical improvement is relatively trouble free is incorrect, as some people on anti-TNFα treatment continue to experience difficulties in all occupational domains, particularly work. People on anti-TNFα treatment do not routinely have access to occupational therapy services. Further research needs to explore the nuanced experiences of treatment and the role of occupational therapy in maximising the treatment potential of anti-TNFα.
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Affiliation(s)
- Margaret McArthur
- Honorary Fellow, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Linda Birt
- Research Associate, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Lynne Goodacre
- Research Fellow, Lancaster University, School of Medicine and Health Sciences, Lancaster
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Verstappen SM. Outcomes of early rheumatoid arthritis – The WHO ICF framework. Best Pract Res Clin Rheumatol 2013; 27:555-70. [DOI: 10.1016/j.berh.2013.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
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Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, Mease P, Olivieri I, Reveille J, Ritchlin C, Rudwaleit M, Schoels M, Sieper J, Wit MD, Baraliakos X, Betteridge N, Burgos-Vargas R, Collantes-Estevez E, Deodhar A, Elewaut D, Gossec L, Jongkees M, Maccarone M, Redlich K, van den Bosch F, Wei JCC, Winthrop K, van der Heijde D. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis 2013; 73:6-16. [PMID: 23749611 PMCID: PMC3888616 DOI: 10.1136/annrheumdis-2013-203419] [Citation(s) in RCA: 304] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). OBJECTIVE To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. METHODS Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. RESULTS Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated. CONCLUSIONS The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna, Austria
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